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Building Ontologies from the Ground Up

When users set out to model their professional activity

Mark A. MusenProfessor of Medicine and Computer Science

Stanford University

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“An ontology is a specification of a conceptualization” (T. Gruber)

• A conceptualization is the way we think about a domain

• A specification provides a formal way of writing it down

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Supreme genus: SUBSTANCE

Subordinate genera: BODY SPIRIT

Differentiae: material immaterial

Differentiae: animate inanimate

Differentiae: sensitive insensitive

Subordinate genera: LIVING MINERAL

Proximate genera: ANIMAL PLANT

Species: HUMAN BEAST

Differentiae: rational irrational

Individuals: Socrates Plato Aristotle …

Porphyry’s depiction of Aristotle’s Categories

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Creating Ontologies in Machine-Processable Form

• Provides a mechanism for developers to codify salient distinctions about the world or some application area

• Provides a structure for knowledge bases that can enable– Information retrieval

– Information integration

– Automated translation

– Decision support

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Ontologies are cropping up everywhere!

• Indexing of online information for access by humans or search engines

• Product catalogs for e-commerce• Reference terminologies for

machine translation and data interchange

• Standard terms for describing experimental data

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The New Philosophers

• Categorizing “what exists” in machine-understandable form

• Providing a structure that enables– Developers to locate and update relevant

descriptions – Computers to infer relationships and properties

• Creating new abstractions to facilitate the creation of this structure

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Part of the CYC Upper Ontology

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There is a misconception …

• That people building ontologies are all well versed in metaphysics, computer science, knowledge representation, and the content domain

• That ontologies in the real world are as “clean” as SUMO, DOLCE, and other upper-level ontologies

• That most people who are creating ontologies understand all the ramifications of what they are doing!

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Lots of ontology builders are not very good philosophers

• Nearly always, ontologies are created to address pressing professional needs

• The people who have the most insight into professional knowledge may have little appreciation for metaphysics, principles of knowledge representation, or computational logic

• There simply aren’t enough good philosophers to go around

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A case in point: The International Classification of Diseases

• An enumeration of diseases that forms the basis for all medical claims and reimbursements in the United States

• A “legacy” terminology that has its roots in 19th century epidemiology

• Created initially by biostatisticians with a pressing need to compare death statistics in different European countries

• A system that won’t go away—and yet we would never create anything like it again

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The notion of disease emerged in the 17th century

• Thomas Sydenham: “The selfsame phenomena that you observe in the sickness of a Socrates you would observe in the sickness of a simpleton”– Description of a plant applies to its species;– Description of disease should be similar

• Over the next 100 years, diverse classification systems for diseases emerged

• Emphasis became to understand disease in terms of associate pathological findings at autopsy

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The Origins of the International Classification of Diseases

• First International Statistical Congress, 1853, initially commissioned development of a nomenclature for coding causes of death

• The resulting nomenclature was revised in 1855, 1864, 1874, 1880, 1886, with continued confusion as to how diseases should be classified

• In 1891, Jacques Bertillon generated a synthesis organized largely anatomically; adopted by the International Statistical Institute in 1893 as the International List of Causes of Death

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The ICD becomes an International Standard

• In 1948, the World Health Organization became responsible for the International List of Causes of Death

• Nonfatal diseases were then added to the list, in the course of multiple revisions to what then became the ICD

• The Ninth revision, ICD-9 was released in 1977• In 1978, after “clinical modification,” ICD-9-CM

became a source taxonomy “for statistics concerning the planning, monitoring, and evaluation of health services”

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A Small Portion of ICD9-CM724 Unspecified disorders of the back724.0 Spinal stenosis, other than cervical724.00 Spinal stenosis, unspecified region724.01 Spinal stenosis, thoracic region724.02 Spinal stenosis, lumbar region724.09 Spinal stenosis, other724.1 Pain in thoracic spine724.2 Lumbago724.3 Sciatica724.4 Thoracic or lumbosacral neuritis724.5 Backache, unspecified724.6 Disorders of sacrum724.7 Disorders of coccyx724.70 Unspecified disorder of coccyx724.71 Hypermobility of coccyx724.71 Coccygodynia724.8 Other symptoms referable to back724.9 Other unspecified back disorders

Enumerative schemes are finite and fixed

Hard to add terms

Hard to find terms

Definitions of terms are informal at best

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ICD9 (1977): A Handful of Codes for Traffic Accidents

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ICD10 (1999): 587 codes for such accidents

topClassI Certain infectious and parasitic diseasesII NeoplasmsIII Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanismIV Endocrine, nutritional and metabolic diseasesV Mental and behavioural disordersVI Diseases of the nervous systemVII Diseases of the eye and adnexaVIII Diseases of the ear and mastoid processIX Diseases of the circulatory systemsX Diseases of the respiratory systemXI Diseases of the digestive systemXII Diseases of the skin and subcutaneous tissueXIII Diseases of the musculoskeletal system and connective tissueXIV Diseases of the genitourinary systemXV Pregnancy, childbirth and the puerperiumXVI Certain conditions originating in the perinatal periodXVII Congenital malformations, deformations and chromosomal abnormalitiesXVIII Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classifiedXIX Injury, poisoning and certain other consequences of external causesXX External causes of morbidity and mortality

V01-V99 Transport accidentsV01-V09 Pedestrian injured in transport accidentV10-V19 Pedal cyclist injured in transport accident

V10 Pedal cyclist injured in collision with pedestrian or animalV10.0 Pedal cyclist injured in collision with pedestrian or animal, driver, nontraffic accident

V10.00 Pedal cyclist injured in collision with pedestrian or animal, driver, nontraffic accident, while engaged in sports activityV10.01 Pedal cyclist injured in collision with pedestrian or animal, driver, nontraffic accident, while engaged in leisure activityV10.02 Pedal cyclist injured in collision with pedestrian or animal, driver, nontraffic accident, while working for an incomeV10.03 Pedal cyclist injured in collision with pedestrian or animal, driver, nontraffic accident, while engaged in other types of workV10.04 Pedal cyclist injured in collision with pedestrian or animal, driver, nontraffic accident, while resting, sleeping, eating or engaging in other vital activitiesV10.08 Pedal cyclist injured in collision with pedestrian or animal, driver, nontraffic accident, while engaged in other specified activitiesV10.09 Pedal cyclist injured in collision with pedestrian or animal, driver, nontraffic accident, during unspecified activity

V10.1 Pedal cyclist injured in collision with pedestrian or animal, passenger, nontraffic accidentV10.10 Pedal cyclist injured in collision with pedestrian or animal, passenger, nontraffic accident, while engaged in sports activityV10.11 Pedal cyclist injured in collision with pedestrian or animal, passenger, nontraffic accident, while engaged in leisure activityV10.12 Pedal cyclist injured in collision with pedestrian or animal, passenger, nontraffic accident, while working for an incomeV10.13 Pedal cyclist injured in collision with pedestrian or animal, passenger, nontraffic accident, while engaged in other types of workV10.14 Pedal cyclist injured in collision with pedestrian or animal, passenger, nontraffic accident, while resting, sleeping, eating or engaging in other vital activitiesV10.18 Pedal cyclist injured in collision with pedestrian or animal, passenger, nontraffic accident, while engaged in other specified activitiesV10.19 Pedal cyclist injured in collision with pedestrian or animal, passenger, nontraffic accident, during unspecified activity

V10.2 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, nontraffic accidentV10.20 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, nontraffic accident, while engaged in sports activityV10.21 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, nontraffic accident, while engaged in leisure activityV10.22 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, nontraffic accident, while working for an incomeV10.23 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, nontraffic accident, while engaged in other types of workV10.24 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activitiesV10.28 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, nontraffic accident, while engaged in other specified activitiesV10.29 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, nontraffic accident, during unspecified activity

V10.3 Pedal cyclist injured in collision with pedestrian or animal, while boarding or alightingV10.30 Pedal cyclist injured in collision with pedestrian or animal, while boarding or alighting, while engaged in sports activityV10.31 Pedal cyclist injured in collision with pedestrian or animal, while boarding or alighting, while engaged in leisure activityV10.32 Pedal cyclist injured in collision with pedestrian or animal, while boarding or alighting, while working for an incomeV10.33 Pedal cyclist injured in collision with pedestrian or animal, while boarding or alighting, while engaged in other types of workV10.34 Pedal cyclist injured in collision with pedestrian or animal, while boarding or alighting, while resting, sleeping, eating or engaging in other vital activitiesV10.38 Pedal cyclist injured in collision with pedestrian or animal, while boarding or alighting, while engaged in other specified activitiesV10.39 Pedal cyclist injured in collision with pedestrian or animal, while boarding or alighting, during unspecified activity

V10.4 Pedal cyclist injured in collision with pedestrian or animal, driver, traffic accidentV10.40 Pedal cyclist injured in collision with pedestrian or animal, driver, traffic accident, while engaged in sports activityV10.41 Pedal cyclist injured in collision with pedestrian or animal, driver, traffic accident, while engaged in leisure activityV10.42 Pedal cyclist injured in collision with pedestrian or animal, driver, traffic accident, while working for an incomeV10.43 Pedal cyclist injured in collision with pedestrian or animal, driver, traffic accident, while engaged in other types of workV10.44 Pedal cyclist injured in collision with pedestrian or animal, driver, traffic accident, while resting, sleeping, eating or engaging in other vital activitiesV10.48 Pedal cyclist injured in collision with pedestrian or animal, driver, traffic accident, while engaged in other specified activitiesV10.49 Pedal cyclist injured in collision with pedestrian or animal, driver, traffic accident, during unspecified activity

V10.5 Pedal cyclist injured in collision with pedestrian or animal, passenger, traffic accidentV10.50 Pedal cyclist injured in collision with pedestrian or animal, passenger, traffic accident, while engaged in sports activityV10.51 Pedal cyclist injured in collision with pedestrian or animal, passenger, traffic accident, while engaged in leisure activityV10.52 Pedal cyclist injured in collision with pedestrian or animal, passenger, traffic accident, while working for an incomeV10.53 Pedal cyclist injured in collision with pedestrian or animal, passenger, traffic accident, while engaged in other types of workV10.54 Pedal cyclist injured in collision with pedestrian or animal, passenger, traffic accident, while resting, sleeping, eating or engaging in other vital activitiesV10.58 Pedal cyclist injured in collision with pedestrian or animal, passenger, traffic accident, while engaged in other specified activitiesV10.59 Pedal cyclist injured in collision with pedestrian or animal, passenger, traffic accident, during unspecified activity

V10.9 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, traffic accidentV10.90 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, traffic accident, while engaged in sports activityV10.91 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, traffic accident, while engaged in leisure activityV10.92 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, traffic accident, while working for an incomeV10.93 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, traffic accident, while engaged in other types of workV10.94 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, traffic accident, while resting, sleeping, eating or engaging in other vital activitiesV10.98 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, traffic accident, while engaged in other specified activitiesV10.99 Pedal cyclist injured in collision with pedestrian or animal, unspecified pedal cyclist, traffic accident, during unspecified activity

V11 Pedal cyclist injured in collision with other pedal cycleV11.0 Pedal cyclist injured in collision with other pedal cycle, driver, nontraffic accident

V11.00 Pedal cyclist injured in collision with other pedal cycle, driver, nontraffic accident, while engaged in sports activityV11.01 Pedal cyclist injured in collision with other pedal cycle, driver, nontraffic accident, while engaged in leisure activityV11.02 Pedal cyclist injured in collision with other pedal cycle, driver, nontraffic accident, while working for an incomeV11.03 Pedal cyclist injured in collision with other pedal cycle, driver, nontraffic accident, while engaged in other types of workV11.04 Pedal cyclist injured in collision with other pedal cycle, driver, nontraffic accident, while resting, sleeping, eating or engaging in other vital activitiesV11.08 Pedal cyclist injured in collision with other pedal cycle, driver, nontraffic accident, while engaged in other specified activitiesV11.09 Pedal cyclist injured in collision with other pedal cycle, driver, nontraffic accident, during unspecified activity

V11.1 Pedal cyclist injured in collision with other pedal cycle, passenger, nontraffic accidentV11.10 Pedal cyclist injured in collision with other pedal cycle, passenger, nontraffic accident, while engaged in sports activityV11.11 Pedal cyclist injured in collision with other pedal cycle, passenger, nontraffic accident, while engaged in leisure activityV11.12 Pedal cyclist injured in collision with other pedal cycle, passenger, nontraffic accident, while working for an incomeV11.13 Pedal cyclist injured in collision with other pedal cycle, passenger, nontraffic accident, while engaged in other types of workV11.14 Pedal cyclist injured in collision with other pedal cycle, passenger, nontraffic accident, while resting, sleeping, eating or engaging in other vital activitiesV11.18 Pedal cyclist injured in collision with other pedal cycle, passenger, nontraffic accident, while engaged in other specified activitiesV11.19 Pedal cyclist injured in collision with other pedal cycle, passenger, nontraffic accident, during unspecified activity

V11.2 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, nontraffic accidentV11.20 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, nontraffic accident, while engaged in sports activityV11.21 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, nontraffic accident, while engaged in leisure activityV11.22 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, nontraffic accident, while working for an incomeV11.23 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, nontraffic accident, while engaged in other types of workV11.24 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activitiesV11.28 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, nontraffic accident, while engaged in other specified activitiesV11.29 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, nontraffic accident, during unspecified activity

V11.3 Pedal cyclist injured in collision with other pedal cycle, while boarding or alightingV11.30 Pedal cyclist injured in collision with other pedal cycle, while boarding or alighting, while engaged in sports activityV11.31 Pedal cyclist injured in collision with other pedal cycle, while boarding or alighting, while engaged in leisure activityV11.32 Pedal cyclist injured in collision with other pedal cycle, while boarding or alighting, while working for an incomeV11.33 Pedal cyclist injured in collision with other pedal cycle, while boarding or alighting, while engaged in other types of workV11.34 Pedal cyclist injured in collision with other pedal cycle, while boarding or alighting, while resting, sleeping, eating or engaging in other vital activitiesV11.38 Pedal cyclist injured in collision with other pedal cycle, while boarding or alighting, while engaged in other specified activitiesV11.39 Pedal cyclist injured in collision with other pedal cycle, while boarding or alighting, during unspecified activity

V11.4 Pedal cyclist injured in collision with other pedal cycle, driver, traffic accidentV11.40 Pedal cyclist injured in collision with other pedal cycle, driver, traffic accident, while engaged in sports activityV11.41 Pedal cyclist injured in collision with other pedal cycle, driver, traffic accident, while engaged in leisure activityV11.42 Pedal cyclist injured in collision with other pedal cycle, driver, traffic accident, while working for an incomeV11.43 Pedal cyclist injured in collision with other pedal cycle, driver, traffic accident, while engaged in other types of workV11.44 Pedal cyclist injured in collision with other pedal cycle, driver, traffic accident, while resting, sleeping, eating or engaging in other vital activitiesV11.48 Pedal cyclist injured in collision with other pedal cycle, driver, traffic accident, while engaged in other specified activitiesV11.49 Pedal cyclist injured in collision with other pedal cycle, driver, traffic accident, during unspecified activity

V11.5 Pedal cyclist injured in collision with other pedal cycle, passenger, traffic accidentV11.50 Pedal cyclist injured in collision with other pedal cycle, passenger, traffic accident, while engaged in sports activityV11.51 Pedal cyclist injured in collision with other pedal cycle, passenger, traffic accident, while engaged in leisure activityV11.52 Pedal cyclist injured in collision with other pedal cycle, passenger, traffic accident, while working for an incomeV11.53 Pedal cyclist injured in collision with other pedal cycle, passenger, traffic accident, while engaged in other types of workV11.54 Pedal cyclist injured in collision with other pedal cycle, passenger, traffic accident, while resting, sleeping, eating or engaging in other vital activitiesV11.58 Pedal cyclist injured in collision with other pedal cycle, passenger, traffic accident, while engaged in other specified activitiesV11.59 Pedal cyclist injured in collision with other pedal cycle, passenger, traffic accident, during unspecified activity

V11.9 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, traffic accidentV11.90 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, traffic accident, while engaged in sports activityV11.91 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, traffic accident, while engaged in leisure activityV11.92 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, traffic accident, while working for an incomeV11.93 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, traffic accident, while engaged in other types of workV11.94 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, traffic accident, while resting, sleeping, eating or engaging in other vital activitiesV11.98 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, traffic accident, while engaged in other specified activitiesV11.99 Pedal cyclist injured in collision with other pedal cycle, unspecified pedal cyclist, traffic accident, during unspecified activity

V12 Pedal cyclist injured in collision with two- or three-wheeled motor vehicleV12.0 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, nontraffic accident

V12.00 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, nontraffic accident, while engaged in sports activityV12.01 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, nontraffic accident, while engaged in leisure activityV12.02 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, nontraffic accident, while working for an incomeV12.03 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, nontraffic accident, while engaged in other types of workV12.04 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, nontraffic accident, while resting, sleeping, eating or engaging in other vital activitiesV12.08 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, nontraffic accident, while engaged in other specified activitiesV12.09 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, nontraffic accident, during unspecified activity

V12.1 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, nontraffic accidentV12.10 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, nontraffic accident, while engaged in sports activityV12.11 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, nontraffic accident, while engaged in leisure activityV12.12 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, nontraffic accident, while working for an incomeV12.13 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, nontraffic accident, while engaged in other types of workV12.14 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, nontraffic accident, while resting, sleeping, eating or engaging in other vital activitiesV12.18 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, nontraffic accident, while engaged in other specified activitiesV12.19 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, nontraffic accident, during unspecified activity

V12.2 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accidentV12.20 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in sports activityV12.21 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in leisure activityV12.22 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, while working for an incomeV12.23 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in other types of workV12.24 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other

vital activitiesV12.28 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in other specified activitiesV12.29 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, during unspecified activity

V12.3 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, while boarding or alighting

V12.30 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, while boarding or alighting, while engaged in sports activity

V12.31 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, while boarding or alighting, while engaged in leisure activity

V12.32 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, while boarding or alighting, while working for an income

V12.33 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, while boarding or alighting, while engaged in other types of work

V12.34 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, while boarding or alighting, while resting, sleeping, eating or engaging in other vital activities

V12.38 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, while boarding or alighting, while engaged in other specified activities

V12.39 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, while boarding or alighting, during unspecified activity

V12.4 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, traffic accident

V12.40 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, traffic accident, while engaged in sports activity

V12.41 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, traffic accident, while engaged in leisure activity

V12.42 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, traffic accident, while working for an income

V12.43 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, traffic accident, while engaged in other types of work

V12.44 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V12.48 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, traffic accident, while engaged in other specified activities

V12.49 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, driver, traffic accident, during unspecified activity

V12.5 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, traffic accident

V12.50 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, traffic accident, while engaged in sports activity

V12.51 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, traffic accident, while engaged in leisure activity

V12.52 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, traffic accident, while working for an income

V12.53 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, traffic accident, while engaged in other types of work

V12.54 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V12.58 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, traffic accident, while engaged in other specified activities

V12.59 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, passenger, traffic accident, during unspecified activity

V12.9 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, traffic accident

V12.90 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, traffic accident, while engaged in sports activity

V12.91 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, traffic accident, while engaged in leisure activity

V12.92 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, traffic accident, while working for an income

V12.93 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, traffic accident, while engaged in other types of work

V12.94 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V12.98 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, traffic accident, while engaged in other specified activities

V12.99 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, traffic accident, during unspecified activity

V13 Pedal cyclist injured in collision with car, pick-up truck or van

V13.0 Pedal cyclist injured in collision with car, pick-up truck or van, driver, nontraffic accident

V13.00 Pedal cyclist injured in collision with car, pick-up truck or van, driver, nontraffic accident, while engaged in sports activity

V13.01 Pedal cyclist injured in collision with car, pick-up truck or van, driver, nontraffic accident, while engaged in leisure activity

V13.02 Pedal cyclist injured in collision with car, pick-up truck or van, driver, nontraffic accident, while working for an income

V13.03 Pedal cyclist injured in collision with car, pick-up truck or van, driver, nontraffic accident, while engaged in other types of work

V13.04 Pedal cyclist injured in collision with car, pick-up truck or van, driver, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V13.08 Pedal cyclist injured in collision with car, pick-up truck or van, driver, nontraffic accident, while engaged in other specified activities

V13.09 Pedal cyclist injured in collision with car, pick-up truck or van, driver, nontraffic accident, during unspecified activity

V13.1 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, nontraffic accident

V13.10 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, nontraffic accident, while engaged in sports activity

V13.11 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, nontraffic accident, while engaged in leisure activity

V13.12 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, nontraffic accident, while working for an income

V13.13 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, nontraffic accident, while engaged in other types of work

V13.14 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V13.18 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, nontraffic accident, while engaged in other specified activities

V13.19 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, nontraffic accident, during unspecified activity

V13.2 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, nontraffic accident

V13.20 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, nontraffic accident, while engaged in sports activity

V13.21 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, nontraffic accident, while engaged in leisure activity

V13.22 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, nontraffic accident, while working for an income

V13.23 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, nontraffic accident, while engaged in other types of work

V13.24 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V13.28 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, nontraffic accident, while engaged in other specified activities

V13.29 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, nontraffic accident, during unspecified activity

V13.3 Pedal cyclist injured in collision with car, pick-up truck or van, while boarding or alighting

V13.30 Pedal cyclist injured in collision with car, pick-up truck or van, while boarding or alighting, while engaged in sports activity

V13.31 Pedal cyclist injured in collision with car, pick-up truck or van, while boarding or alighting, while engaged in leisure activity

V13.32 Pedal cyclist injured in collision with car, pick-up truck or van, while boarding or alighting, while working for an income

V13.33 Pedal cyclist injured in collision with car, pick-up truck or van, while boarding or alighting, while engaged in other types of work

V13.34 Pedal cyclist injured in collision with car, pick-up truck or van, while boarding or alighting, while resting, sleeping, eating or engaging in other vital activities

V13.38 Pedal cyclist injured in collision with car, pick-up truck or van, while boarding or alighting, while engaged in other specified activities

V13.39 Pedal cyclist injured in collision with car, pick-up truck or van, while boarding or alighting, during unspecified activity

V13.4 Pedal cyclist injured in collision with car, pick-up truck or van, driver, traffic accident

V13.40 Pedal cyclist injured in collision with car, pick-up truck or van, driver, traffic accident, while engaged in sports activity

V13.41 Pedal cyclist injured in collision with car, pick-up truck or van, driver, traffic accident, while engaged in leisure activity

V13.42 Pedal cyclist injured in collision with car, pick-up truck or van, driver, traffic accident, while working for an income

V13.43 Pedal cyclist injured in collision with car, pick-up truck or van, driver, traffic accident, while engaged in other types of work

V13.44 Pedal cyclist injured in collision with car, pick-up truck or van, driver, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V13.48 Pedal cyclist injured in collision with car, pick-up truck or van, driver, traffic accident, while engaged in other specified activities

V13.49 Pedal cyclist injured in collision with car, pick-up truck or van, driver, traffic accident, during unspecified activity

V13.5 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, traffic accident

V13.50 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, traffic accident, while engaged in sports activity

V13.51 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, traffic accident, while engaged in leisure activity

V13.52 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, traffic accident, while working for an income

V13.53 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, traffic accident, while engaged in other types of work

V13.54 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V13.58 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, traffic accident, while engaged in other specified activities

V13.59 Pedal cyclist injured in collision with car, pick-up truck or van, passenger, traffic accident, during unspecified activity

V13.9 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, traffic accident

V13.90 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, traffic accident, while engaged in sports activity

V13.91 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, traffic accident, while engaged in leisure activity

V13.92 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, traffic accident, while working for an income

V13.93 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, traffic accident, while engaged in other types of work

V13.94 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V13.98 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, traffic accident, while engaged in other specified activities

V13.99 Pedal cyclist injured in collision with car, pick-up truck or van, unspecified pedal cyclist, traffic accident, during unspecified activity

V14 Pedal cyclist injured in collision with heavy transport vehicle or bus

V14.0 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, nontraffic accident

V14.00 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, nontraffic accident, while engaged in sports activity

V14.01 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, nontraffic accident, while engaged in leisure activity

V14.02 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, nontraffic accident, while working for an income

V14.03 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, nontraffic accident, while engaged in other types of work

V14.04 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V14.08 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, nontraffic accident, while engaged in other specified activities

V14.09 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, nontraffic accident, during unspecified activity

V14.1 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, nontraffic accident

V14.10 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, nontraffic accident, while engaged in sports activity

V14.11 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, nontraffic accident, while engaged in leisure activity

V14.12 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, nontraffic accident, while working for an income

V14.13 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, nontraffic accident, while engaged in other types of work

V14.14 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V14.18 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, nontraffic, while engaged in other specified activities accident

V14.19 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, nontraffic, during unspecified activity accident

V14.2 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, nontraffic accident

V14.20 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, nontraffic accident, while engaged in sports activity

V14.21 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, nontraffic accident, while engaged in leisure activity

V14.22 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, nontraffic accident, while working for an income

V14.23 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, nontraffic accident, while engaged in other types of work

V14.24 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V14.28 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, nontraffic accident, while engaged in other specified activities

V14.29 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, nontraffic accident, during unspecified activity

V14.3 Pedal cyclist injured in collision with heavy transport vehicle or bus, while boarding or alighting

V14.30 Pedal cyclist injured in collision with heavy transport vehicle or bus, while boarding or alighting, while engaged in sports activity

V14.31 Pedal cyclist injured in collision with heavy transport vehicle or bus, while boarding or alighting, while engaged in leisure activity

V14.32 Pedal cyclist injured in collision with heavy transport vehicle or bus, while boarding or alighting, while working for an income

V14.33 Pedal cyclist injured in collision with heavy transport vehicle or bus, while boarding or alighting, while engaged in other types of work

V14.34 Pedal cyclist injured in collision with heavy transport vehicle or bus, while boarding or alighting, while resting, sleeping, eating or engaging in other vital activities

V14.38 Pedal cyclist injured in collision with heavy transport vehicle or bus, while boarding or alighting, while engaged in other specified activities

V14.39 Pedal cyclist injured in collision with heavy transport vehicle or bus, while boarding or alighting, during unspecified activity

V14.4 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, traffic accident

V14.40 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, traffic accident, while engaged in sports activity

V14.41 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, traffic accident, while engaged in leisure activity

V14.42 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, traffic accident, while working for an income

V14.43 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, traffic accident, while engaged in other types of work

V14.44 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V14.48 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, traffic accident, while engaged in other specified activities

V14.49 Pedal cyclist injured in collision with heavy transport vehicle or bus, driver, traffic accident, during unspecified activity

V14.5 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, traffic accident

V14.50 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, traffic accident, while engaged in sports activity

V14.51 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, traffic accident, while engaged in leisure activity

V14.52 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, traffic accident, while working for an income

V14.53 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, traffic accident, while engaged in other types of work

V14.54 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V14.58 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, traffic accident, while engaged in other specified activities

V14.59 Pedal cyclist injured in collision with heavy transport vehicle or bus, passenger, traffic accident, during unspecified activity

V14.9 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, traffic accident

V14.90 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, traffic accident, while engaged in sports activity

V14.91 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, traffic accident, while engaged in leisure activity

V14.92 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, traffic accident, while working for an income

V14.93 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, traffic accident, while engaged in other types of work

V14.94 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V14.98 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, traffic accident, while engaged in other specified activities

V14.99 Pedal cyclist injured in collision with heavy transport vehicle or bus, unspecified pedal cyclist, traffic accident, during unspecified activity

V15 Pedal cyclist injured in collision with railway train or railway vehicle

V15.0 Pedal cyclist injured in collision with railway train or railway vehicle, driver, nontraffic accident

V15.00 Pedal cyclist injured in collision with railway train or railway vehicle, driver, nontraffic accident, while engaged in sports activity

V15.01 Pedal cyclist injured in collision with railway train or railway vehicle, driver, nontraffic accident, while engaged in leisure activity

V15.02 Pedal cyclist injured in collision with railway train or railway vehicle, driver, nontraffic accident, while working for an income

V15.03 Pedal cyclist injured in collision with railway train or railway vehicle, driver, nontraffic accident, while engaged in other types of work

V15.04 Pedal cyclist injured in collision with railway train or railway vehicle, driver, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V15.08 Pedal cyclist injured in collision with railway train or railway vehicle, driver, nontraffic accident, while engaged in other specified activities

V15.09 Pedal cyclist injured in collision with railway train or railway vehicle, driver, nontraffic accident, during unspecified activity

V15.1 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, nontraffic accident

V15.10 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, nontraffic accident, while engaged in sports activity

V15.11 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, nontraffic accident, while engaged in leisure activity

V15.12 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, nontraffic accident, while working for an income

V15.13 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, nontraffic accident, while engaged in other types of work

V15.14 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V15.18 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, nontraffic accident, while engaged in other specified activities

V15.19 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, nontraffic accident, during unspecified activity

V15.2 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, nontraffic accident

V15.20 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in sports activity

V15.21 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in leisure activity

V15.22 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, nontraffic accident, while working for an income

V15.23 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in other types of work

V15.24 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V15.28 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in other specified activities

V15.29 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, nontraffic accident, during unspecified activity

V15.3 Pedal cyclist injured in collision with railway train or railway vehicle, while boarding or alighting

V15.30 Pedal cyclist injured in collision with railway train or railway vehicle, while boarding or alighting, while engaged in sports activity

V15.31 Pedal cyclist injured in collision with railway train or railway vehicle, while boarding or alighting, while engaged in leisure activity

V15.32 Pedal cyclist injured in collision with railway train or railway vehicle, while boarding or alighting, while working for an income, while working for an income

V15.33 Pedal cyclist injured in collision with railway train or railway vehicle, while boarding or alighting, while engaged in other types of work

V15.34 Pedal cyclist injured in collision with railway train or railway vehicle, while boarding or alighting, while resting, sleeping, eating or engaging in other vital activities

V15.38 Pedal cyclist injured in collision with railway train or railway vehicle, while boarding or alighting, while engaged in other specified activities

V15.39 Pedal cyclist injured in collision with railway train or railway vehicle, while boarding or alighting, during unspecified activity

V15.4 Pedal cyclist injured in collision with railway train or railway vehicle, driver, traffic accident

V15.40 Pedal cyclist injured in collision with railway train or railway vehicle, driver, traffic accident, while engaged in sports activity

V15.41 Pedal cyclist injured in collision with railway train or railway vehicle, driver, traffic accident, while engaged in leisure activity

V15.42 Pedal cyclist injured in collision with railway train or railway vehicle, driver, traffic accident, while working for an income

V15.43 Pedal cyclist injured in collision with railway train or railway vehicle, driver, traffic accident, while engaged in other types of work

V15.44 Pedal cyclist injured in collision with railway train or railway vehicle, driver, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V15.48 Pedal cyclist injured in collision with railway train or railway vehicle, driver, traffic accident, while engaged in other specified activities

V15.49 Pedal cyclist injured in collision with railway train or railway vehicle, driver, traffic accident, during unspecified activity

V15.5 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, traffic accident

V15.50 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, traffic accident, while engaged in sports activity

V15.51 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, traffic accident, while engaged in leisure activity

V15.52 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, traffic accident, while working for an income

V15.53 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, traffic accident, while engaged in other types of work

V15.54 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V15.58 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, traffic accident, while engaged in other specified activities

V15.59 Pedal cyclist injured in collision with railway train or railway vehicle, passenger, traffic accident, during unspecified activity

V15.9 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, traffic accident

V15.90 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, traffic accident, while engaged in sports activity

V15.91 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, traffic accident, while engaged in leisure activity

V15.92 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, traffic accident, while working for an income

V15.93 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, traffic accident, while engaged in other types of work

V15.94 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V15.98 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, traffic accident, while engaged in other specified activities

V15.99 Pedal cyclist injured in collision with railway train or railway vehicle, unspecified pedal cyclist, traffic accident, during unspecified activity

V16 Pedal cyclist injured in collision with other nonmotor vehicle

V16.0 Pedal cyclist injured in collision with other nonmotor vehicle, driver, nontraffic accident

V16.00 Pedal cyclist injured in collision with other nonmotor vehicle, driver, nontraffic accident, while engaged in sports activity

V16.01 Pedal cyclist injured in collision with other nonmotor vehicle, driver, nontraffic accident, while engaged in leisure activity

V16.02 Pedal cyclist injured in collision with other nonmotor vehicle, driver, nontraffic accident, while working for an income

V16.03 Pedal cyclist injured in collision with other nonmotor vehicle, driver, nontraffic accident, while engaged in other types of work

V16.04 Pedal cyclist injured in collision with other nonmotor vehicle, driver, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V16.08 Pedal cyclist injured in collision with other nonmotor vehicle, driver, nontraffic accident, while engaged in other specified activities

V16.09 Pedal cyclist injured in collision with other nonmotor vehicle, driver, nontraffic accident, during unspecified activity

V16.1 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, nontraffic accident

V16.10 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, nontraffic accident, while engaged in sports activity

V16.11 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, nontraffic accident, while engaged in leisure activity

V16.12 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, nontraffic accident, while working for an income

V16.13 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, nontraffic accident, while engaged in other types of work

V16.14 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V16.18 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, nontraffic accident, while engaged in other specified activities

V16.19 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, nontraffic accident, during unspecified activity

V16.2 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, nontraffic accident

V16.20 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in sports activity

V16.21 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in leisure activity

V16.22 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, nontraffic accident, while working for an income

V16.23 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in other types of work

V16.24 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V16.28 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, nontraffic accident, while engaged in other specified activities

V16.29 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, nontraffic accident, during unspecified activity

V16.3 Pedal cyclist injured in collision with other nonmotor vehicle, while boarding or alighting

V16.30 Pedal cyclist injured in collision with other nonmotor vehicle, while boarding or alighting, while engaged in sports activity

V16.31 Pedal cyclist injured in collision with other nonmotor vehicle, while boarding or alighting, while engaged in leisure activity

V16.32 Pedal cyclist injured in collision with other nonmotor vehicle, while boarding or alighting, while working for an income

V16.33 Pedal cyclist injured in collision with other nonmotor vehicle, while boarding or alighting, while engaged in other types of work

V16.34 Pedal cyclist injured in collision with other nonmotor vehicle, while boarding or alighting, while resting, sleeping, eating or engaging in other vital activities

V16.38 Pedal cyclist injured in collision with other nonmotor vehicle, while boarding or alighting, while engaged in other specified activities

V16.39 Pedal cyclist injured in collision with other nonmotor vehicle, while boarding or alighting, during unspecified activity

V16.4 Pedal cyclist injured in collision with other nonmotor vehicle, driver, traffic accident

V16.40 Pedal cyclist injured in collision with other nonmotor vehicle, driver, traffic accident, while engaged in sports activity

V16.41 Pedal cyclist injured in collision with other nonmotor vehicle, driver, traffic accident, while engaged in leisure activity

V16.42 Pedal cyclist injured in collision with other nonmotor vehicle, driver, traffic accident, while working for an income

V16.43 Pedal cyclist injured in collision with other nonmotor vehicle, driver, traffic accident, while engaged in other types of work

V16.44 Pedal cyclist injured in collision with other nonmotor vehicle, driver, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V16.48 Pedal cyclist injured in collision with other nonmotor vehicle, driver, traffic accident, while engaged in other specified activities

V16.49 Pedal cyclist injured in collision with other nonmotor vehicle, driver, traffic accident, during unspecified activity

V16.5 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, traffic accident

V16.50 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, traffic accident, while engaged in sports activity

V16.51 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, traffic accident, while engaged in leisure activity

V16.52 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, traffic accident, while working for an income

V16.53 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, traffic accident, while engaged in other types of work

V16.54 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V16.58 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, traffic accident, while engaged in other specified activities

V16.59 Pedal cyclist injured in collision with other nonmotor vehicle, passenger, traffic accident, during unspecified activity

V16.9 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, traffic accident

V16.90 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, traffic accident, while engaged in leisure activity

V16.91 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, traffic accident, while engaged in sports activity

V16.92 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, traffic accident, while working for an income

V16.93 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, traffic accident, while engaged in other types of work

V16.94 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V16.98 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, traffic accident, while engaged in other specified activities

V16.99 Pedal cyclist injured in collision with other nonmotor vehicle, unspecified pedal cyclist, traffic accident, during unspecified activity

V17 Pedal cyclist injured in collision with fixed or stationary object

V17.0 Pedal cyclist injured in collision with fixed or stationary object, driver, nontraffic accident

V17.00 Pedal cyclist injured in collision with fixed or stationary object, driver, nontraffic accident, while engaged in sports activity

V17.01 Pedal cyclist injured in collision with fixed or stationary object, driver, nontraffic accident, while engaged in leisure activity

V17.02 Pedal cyclist injured in collision with fixed or stationary object, driver, nontraffic accident, while working for an income

V17.03 Pedal cyclist injured in collision with fixed or stationary object, driver, nontraffic accident, while engaged in other types of work

V17.04 Pedal cyclist injured in collision with fixed or stationary object, driver, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V17.08 Pedal cyclist injured in collision with fixed or stationary object, driver, nontraffic accident, while engaged in other specified activities

V17.09 Pedal cyclist injured in collision with fixed or stationary object, driver, nontraffic accident, during unspecified activity

V17.1 Pedal cyclist injured in collision with fixed or stationary object, passenger, nontraffic accident

V17.10 Pedal cyclist injured in collision with fixed or stationary object, passenger, nontraffic accident, while engaged in sports activity

V17.11 Pedal cyclist injured in collision with fixed or stationary object, passenger, nontraffic accident, while engaged in leisure activity

V17.12 Pedal cyclist injured in collision with fixed or stationary object, passenger, nontraffic accident, while working for an income

V17.13 Pedal cyclist injured in collision with fixed or stationary object, passenger, nontraffic accident, while engaged in other types of work

V17.14 Pedal cyclist injured in collision with fixed or stationary object, passenger, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V17.18 Pedal cyclist injured in collision with fixed or stationary object, passenger, nontraffic accident, while engaged in other specified activities

V17.19 Pedal cyclist injured in collision with fixed or stationary object, passenger, nontraffic accident, during unspecified activity

V17.2 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, nontraffic accident

V17.20 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, nontraffic accident, while engaged in sports activity

V17.21 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, nontraffic accident, while engaged in leisure activity

V17.22 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, nontraffic accident, while working for an income

V17.23 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, nontraffic accident, while engaged in other types of work

V17.24 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V17.28 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, nontraffic accident, while engaged in other specified activities

V17.29 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, nontraffic accident, during unspecified activity

V17.3 Pedal cyclist injured in collision with fixed or stationary object, while boarding or alighting

V17.30 Pedal cyclist injured in collision with fixed or stationary object, while boarding or alighting, while engaged in sports activity

V17.31 Pedal cyclist injured in collision with fixed or stationary object, while boarding or alighting, while engaged in leisure activity

V17.32 Pedal cyclist injured in collision with fixed or stationary object, while boarding or alighting, while working for an income

V17.33 Pedal cyclist injured in collision with fixed or stationary object, while boarding or alighting, while engaged in other types of work

V17.34 Pedal cyclist injured in collision with fixed or stationary object, while boarding or alighting, while resting, sleeping, eating or engaging in other vital activities

V17.38 Pedal cyclist injured in collision with fixed or stationary object, while boarding or alighting, while engaged in other specified activities

V17.39 Pedal cyclist injured in collision with fixed or stationary object, while boarding or alighting, during unspecified activity

V17.4 Pedal cyclist injured in collision with fixed or stationary object, driver, traffic accident

V17.40 Pedal cyclist injured in collision with fixed or stationary object, driver, traffic accident, while engaged in sports activity

V17.41 Pedal cyclist injured in collision with fixed or stationary object, driver, traffic accident, while engaged in leisure activity

V17.42 Pedal cyclist injured in collision with fixed or stationary object, driver, traffic accident, while working for an income

V17.43 Pedal cyclist injured in collision with fixed or stationary object, driver, traffic accident, while engaged in other types of work

V17.44 Pedal cyclist injured in collision with fixed or stationary object, driver, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V17.48 Pedal cyclist injured in collision with fixed or stationary object, driver, traffic accident, while engaged in other specified activities

V17.49 Pedal cyclist injured in collision with fixed or stationary object, driver, traffic accident, during unspecified activity

V17.5 Pedal cyclist injured in collision with fixed or stationary object, passenger, traffic accident

V17.50 Pedal cyclist injured in collision with fixed or stationary object, passenger, traffic accident, while engaged in sports activity

V17.51 Pedal cyclist injured in collision with fixed or stationary object, passenger, traffic accident, while engaged in leisure activity

V17.52 Pedal cyclist injured in collision with fixed or stationary object, passenger, traffic accident, while working for an income

V17.53 Pedal cyclist injured in collision with fixed or stationary object, passenger, traffic accident, while engaged in other types of work

V17.54 Pedal cyclist injured in collision with fixed or stationary object, passenger, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V17.58 Pedal cyclist injured in collision with fixed or stationary object, passenger, traffic accident, while engaged in other specified activities

V17.59 Pedal cyclist injured in collision with fixed or stationary object, passenger, traffic accident, during unspecified activity

V17.9 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, traffic accident

V17.90 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, traffic accident, while engaged in sports activity

V17.91 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, traffic accident, while engaged in leisure activity

V17.92 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, traffic accident, while working for an income

V17.93 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, traffic accident, while engaged in other types of work

V17.94 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V17.98 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, traffic accident, while engaged in other specified activities

V17.99 Pedal cyclist injured in collision with fixed or stationary object, unspecified pedal cyclist, traffic accident, during unspecified activity

V18 Pedal cyclist injured in noncollision transport accident

V18.0 Pedal cyclist injured in noncollision transport accident, driver, nontraffic accident

V18.00 Pedal cyclist injured in noncollision transport accident, driver, nontraffic accident, while engaged in sports activity

V18.01 Pedal cyclist injured in noncollision transport accident, driver, nontraffic accident, while engaged in leisure activity

V18.02 Pedal cyclist injured in noncollision transport accident, driver, nontraffic accident, while working for an income

V18.03 Pedal cyclist injured in noncollision transport accident, driver, nontraffic accident, while engaged in other types of work

V18.04 Pedal cyclist injured in noncollision transport accident, driver, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V18.08 Pedal cyclist injured in noncollision transport accident, driver, nontraffic accident, while engaged in other specified activities

V18.09 Pedal cyclist injured in noncollision transport accident, driver, nontraffic accident, during unspecified activity

V18.1 Pedal cyclist injured in noncollision transport accident, passenger, nontraffic accident

V18.10 Pedal cyclist injured in noncollision transport accident, passenger, nontraffic accident, while engaged in sports activity

V18.11 Pedal cyclist injured in noncollision transport accident, passenger, nontraffic accident, while engaged in leisure activity

V18.12 Pedal cyclist injured in noncollision transport accident, passenger, nontraffic accident, while working for an income

V18.13 Pedal cyclist injured in noncollision transport accident, passenger, nontraffic accident, while engaged in other types of work

V18.14 Pedal cyclist injured in noncollision transport accident, passenger, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V18.18 Pedal cyclist injured in noncollision transport accident, passenger, nontraffic accident, while engaged in other specified activities

V18.19 Pedal cyclist injured in noncollision transport accident, passenger, nontraffic accident, during unspecified activity

V18.2 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, nontraffic accident

V18.20 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, nontraffic accident, while engaged in sports activity

V18.21 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, nontraffic accident, while engaged in leisure activity

V18.22 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, nontraffic accident, while working for an income

V18.23 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, nontraffic accident, while engaged in other types of work

V18.24 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V18.28 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, nontraffic accident, while engaged in other specified activities

V18.29 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, nontraffic accident, during unspecified activity

V18.3 Pedal cyclist injured in noncollision transport accident, while boarding or alighting

V18.30 Pedal cyclist injured in noncollision transport accident, while boarding or alighting, while engaged in sports activity

V18.31 Pedal cyclist injured in noncollision transport accident, while boarding or alighting, while engaged in leisure activity

V18.32 Pedal cyclist injured in noncollision transport accident, while boarding or alighting, while working for an income

V18.33 Pedal cyclist injured in noncollision transport accident, while boarding or alighting, while engaged in other types of work

V18.34 Pedal cyclist injured in noncollision transport accident, while boarding or alighting, while resting, sleeping, eating or engaging in other vital activities

V18.38 Pedal cyclist injured in noncollision transport accident, while boarding or alighting, while engaged in other specified activities

V18.39 Pedal cyclist injured in noncollision transport accident, while boarding or alighting, during unspecified activity

V18.4 Pedal cyclist injured in noncollision transport accident, driver, traffic accident

V18.40 Pedal cyclist injured in noncollision transport accident, driver, traffic accident, while engaged in sports activity

V18.41 Pedal cyclist injured in noncollision transport accident, driver, traffic accident, while engaged in leisure activity

V18.42 Pedal cyclist injured in noncollision transport accident, driver, traffic accident, while working for an income

V18.43 Pedal cyclist injured in noncollision transport accident, driver, traffic accident, while engaged in other types of work

V18.44 Pedal cyclist injured in noncollision transport accident, driver, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V18.48 Pedal cyclist injured in noncollision transport accident, driver, traffic accident, while engaged in other specified activities

V18.49 Pedal cyclist injured in noncollision transport accident, driver, traffic accident, during unspecified activity, during unspecified activity

V18.5 Pedal cyclist injured in noncollision transport accident, passenger, traffic accident

V18.50 Pedal cyclist injured in noncollision transport accident, passenger, traffic accident, while engaged in sports activity

V18.51 Pedal cyclist injured in noncollision transport accident, passenger, traffic accident, while engaged in leisure activity

V18.52 Pedal cyclist injured in noncollision transport accident, passenger, traffic accident, while working for an income, while working for an income

V18.53 Pedal cyclist injured in noncollision transport accident, passenger, traffic accident, while engaged in other types of work

V18.54 Pedal cyclist injured in noncollision transport accident, passenger, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V18.58 Pedal cyclist injured in noncollision transport accident, passenger, traffic accident, while engaged in other specified activities

V18.59 Pedal cyclist injured in noncollision transport accident, passenger, traffic accident, during unspecified activity, during unspecified activity

V18.9 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, traffic accident

V18.90 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, traffic accident, while engaged in sports activity

V18.91 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, traffic accident, while engaged in leisure activity

V18.92 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, traffic accident, while working for an income, while working for an income

V18.93 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, traffic accident, while engaged in other types of work

V18.94 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, traffic accident, while resting, sleeping, eating or engaging in other vital activities

V18.98 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, traffic accident, while engaged in other specified activities

V18.99 Pedal cyclist injured in noncollision transport accident, unspecified pedal cyclist, traffic accident, during unspecified activity, during unspecified activity

V19 Pedal cyclist injured in other and unspecified transport accidents

V19.0 Driver injured in collision with other and unspecified motor vehicles in nontraffic accident

V19.00 Driver injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in sports activity

V19.01 Driver injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in leisure activity

V19.02 Driver injured in collision with other and unspecified motor vehicles in nontraffic accident, while working for an income

V19.03 Driver injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in other types of work

V19.04 Driver injured in collision with other and unspecified motor vehicles in nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V19.08 Driver injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in other specified activities

V19.09 Driver injured in collision with other and unspecified motor vehicles in nontraffic accident, during unspecified activity

V19.1 Passenger injured in collision with other and unspecified motor vehicles in nontraffic accident

V19.10 Passenger injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in sports activity

V19.11 Passenger injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in leisure activity

V19.12 Passenger injured in collision with other and unspecified motor vehicles in nontraffic accident, while working for an income

V19.13 Passenger injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in other types of work

V19.14 Passenger injured in collision with other and unspecified motor vehicles in nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V19.18 Passenger injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in other specified activities

V19.19 Passenger injured in collision with other and unspecified motor vehicles in nontraffic accident, during unspecified activity

V19.2 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in nontraffic accident

V19.20 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in sports activity

V19.21 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in leisure activity

V19.22 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in nontraffic accident, while working for an income

V19.23 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in other types of work

V19.24 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V19.28 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in nontraffic accident, while engaged in other specified activities

V19.29 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in nontraffic accident, during unspecified activity

V19.3 Pedal cyclist [any] injured in unspecified nontraffic accident

V19.30 Pedal cyclist [any] injured in unspecified nontraffic accident, while engaged in sports activity

V19.31 Pedal cyclist [any] injured in unspecified nontraffic accident, while engaged in leisure activity

V19.32 Pedal cyclist [any] injured in unspecified nontraffic accident, while working for an income

V19.33 Pedal cyclist [any] injured in unspecified nontraffic accident, while engaged in other types of work

V19.34 Pedal cyclist [any] injured in unspecified nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

V19.38 Pedal cyclist [any] injured in unspecified nontraffic accident, while engaged in other specified activities

V19.39 Pedal cyclist [any] injured in unspecified nontraffic accident, during unspecified activity

V19.4 Driver injured in collision with other and unspecified motor vehicles in traffic accident

V19.40 Driver injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in sports activity

V19.41 Driver injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in leisure activity

V19.42 Driver injured in collision with other and unspecified motor vehicles in traffic accident, while working for an income

V19.43 Driver injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in other types of work

V19.44 Driver injured in collision with other and unspecified motor vehicles in traffic accident, while resting, sleeping, eating or engaging in other vital activities

V19.48 Driver injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in other specified activities

V19.49 Driver injured in collision with other and unspecified motor vehicles in traffic accident, during unspecified activity

V19.5 Passenger injured in collision with other and unspecified motor vehicles in traffic accident

V19.50 Passenger injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in sports activity

V19.51 Passenger injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in leisure activity

V19.52 Passenger injured in collision with other and unspecified motor vehicles in traffic accident, while working for an income

V19.53 Passenger injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in other types of work

V19.54 Passenger injured in collision with other and unspecified motor vehicles in traffic accident, while resting, sleeping, eating or engaging in other vital activities

V19.58 Passenger injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in other specified activities

V19.59 Passenger injured in collision with other and unspecified motor vehicles in traffic accident, during unspecified activity

V19.6 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in traffic accident

V19.60 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in sports activity

V19.61 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in leisure activity

V19.62 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in traffic accident, while working for an income

V19.63 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in other types of work

V19.64 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in traffic accident, while resting, sleeping, eating or engaging in other vital activities

V19.68 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in traffic accident, while engaged in other specified activities

V19.69 Unspecified pedal cyclist injured in collision with other and unspecified motor vehicles in traffic accident, during unspecified activity

V19.8 Pedal cyclist [any] injured in other specified transport accidents

V19.80 Pedal cyclist [any] injured in other specified transport accidents, while engaged in sports activity

V19.81 Pedal cyclist [any] injured in other specified transport accidents, while engaged in leisure activity

V19.82 Pedal cyclist [any] injured in other specified transport accidents, while working for an income

V19.83 Pedal cyclist [any] injured in other specified transport accidents, while engaged in other types of work

V19.84 Pedal cyclist [any] injured in other specified transport accidents, while resting, sleeping, eating or engaging in other vital activities

V19.88 Pedal cyclist [any] injured in other specified transport accidents, while engaged in other specified activities

V19.89 Pedal cyclist [any] injured in other specified transport accidents, during unspecified activity

V19.9 Pedal cyclist [any] injured in unspecified traffic accident

V19.90 Pedal cyclist [any] injured in unspecified traffic accident, while engaged in sports activity

V19.91 Pedal cyclist [any] injured in unspecified traffic accident, while engaged in leisure activity

V19.92 Pedal cyclist [any] injured in unspecified traffic accident, while working for an income

V19.93 Pedal cyclist [any] injured in unspecified traffic accident, while engaged in other types of work

V19.94 Pedal cyclist [any] injured in unspecified traffic accident, while resting, sleeping, eating or engaging in other vital activities

V19.98 Pedal cyclist [any] injured in unspecified traffic accident, while engaged in other specified activities

V19.99 Pedal cyclist [any] injured in unspecified traffic accident, during unspecified activity

•V31.22 Occupant of three-wheeled motor vehicle injured in collision with pedal cycle, person on outside of vehicle, nontraffic accident, while working for income

•W65.40 Drowning and submersion while in bath-tub, street and highway, while engaged in sports activity

•X35.44 Victim of volcanic eruption, street and highway, while resting, sleeping, eating or engaging in other vital activities

19

ICD is used for lots of (too many?) things!

• ICD is used to code all patient encounters with the health-care system for purposes of– Billing and reimbursement– Institutional planning– Disease surveillance and public health– Quality assurance– Economic modeling by third-party payors

• ICD was never intended to make the distinctions relevant to all these tasks!

• When patient encounters are encoded with ICD, it is impossible to keep all these uses in mind

20

If real ontologists could build the ICD from scratch …

• Diseases would be organized with well-defined relationships

• Diseases would be associated with computer-understandable definitions

• There would be well-defined rules to enable aggregation of primitive concepts into complex descriptions—and for ensuring that those descriptions were sensible

• There would be well-defined mechanisms for creating use-specific views of the ICD

21

The pressing need to standardize the names of human genes

22

But the human genome is only part of the problem …

• Scientist maintain huge databases of gene sequences and gene expression for a wide range of “model organisms” (e.g., mouse, rat, yeast, fruit fly, round worm, slime mold)

• Database entries are annotated with the entries such as the name of a gene, the function of the gene, and so on

• How do you ensure uniformity in the nature of these annotations?

23

Gene Ontology Consortium

• Founded in 1998 as a collaboration among scientists responsible for developing different databases of genomic data for model organisms (fruit fly, yeast, mouse)

• Now, essentially all developers of all model-organism databases participate

• Goal: To produce a dynamic, controlled vocabulary that can be applied to all organism databases even as knowledge of gene and protein roles in cells is accumulating and changing

24

Gene Ontology (GO)

• Comprises three independent “ontologies”

– molecular function of gene products

– cellular component of gene products

– biological process representing the gene product’s higher order role.

• Uses these terms as attributes of gene products in the collaborating databases (gene product associations)

• Allows queries across databases using GO terms, providing linkage of biological information across species

25

GO = Three OntologiesGO = Three Ontologies

• Molecular Function – elemental activity or task

– example: DNA binding

• Cellular Component – location or complex

– example: cell nucleus

• Biological Process – goal or objective within cell

– example: secretion

26

27

GO has been wildly successful!!

• Dozens of biologists around the world contribute to GO on a regular basis

• The ontology is updated every 30 minutes!

• It’s now impossible to work in most areas of computational biology without making use of GO terms

28

But GO has real problems …

• Ontologies are represented in an idiosyncratic format that is not compatible with standard knowledge-representation systems

• The format is based on directed acyclic graphs of concepts, without the general ability to specify machine interpretable properties of concepts or definitions of concepts

• Because of the informal knowledge-representation system, lots of errors have crept into GO– Terms that are duplicated in different places– Terms with no superclasses– Uncertain relationships between terms

29

30

Tension in the GO Community

• Biologists around the world with pressing needs to integrate research databases work together to add terms to GO nearly continuously– Using an impoverished, nonstandard knowledge-

representation system– Using no standards to assure uniform modeling

conventions from one part of GO to another

• Computer scientists bemoan all this ad-hoc-ery and condemn GO as a hack that will become increasingly unusable and unmaintainable

31

The Capulets and MontaguesA plague on both your houses?

Professor Carole GobleUniversity of Manchester, UK

Warning: This talk contains sweeping generalisations

A wonderful keynote talk from the recent meeting on Standards and Ontologies for Functional Genomics

32

PrologueTwo households, both alike in dignity,In fair genomics, where we lay our scene,(One, comforted by its logic’s rigour,Claims ontology for the realm of pure,The other, with blessed scientist’s vigour,Acts hastily on models that endure),From ancient grudge break to new mutiny,When “being” drives a fly-man to blaspheme.From forth the fatal loins of these two foesResearchers to unlock the book of life;Whole misadventured piteous overthrowsCan with their work bury their clans’ strife.The fruitful passage of their GO-mark'd love,And the continuance of their studies sage,Which, united, yield ontologies undreamed-of,Is now the hours' traffic of our stage;The which if you with patient ears attend,What here shall miss, our toil shall strive to mend.

Based on an idea by Shakespeare

Carole Goble

33

The Montagues

Computer Science, Knowledge engineering, AILogic and Languages

TheoryTop down, well-behaved neatness

Generic and lots of toysMethodologies & patterns

Tools and standardsTechnology pushAcademic pursuit

One, comforted by its logic’s rigour,

Claims ontology for the realm of pure

Carole Goble

34

The Capulets

Life ScientistsPractice

Bottom up, real-worldSpecific and many of them

Methodologies, community practiceTools and standards

Application pullPractical pursuit – build ‘n’ use it

The other, with blessed scientist’s vigour,

Acts hastily on models that endure

Carole Goble

35

The Philosophers

PhilosophersTheoryTruth

Generic – the one true ontology?Methodologies, patterns & foundational ontologies

Not really into tools No push or pull

Academic pursuit

One, comforted by its logic’s rigour,

Claims ontology for the realm of pure

Carole Goble

36

Pragm

atists

Aesthetics

Philosophers

Life ScientistsCapulets

KRMontagues

A means to an endContent providers

Theo

retic

ians

The endMechanism providers

Endurants, Perdurants,Being, Substance, Event

Spi

ritua

l gui

des

Carole Goble

37

The Princes of Genomics

Rebellious subjects, enemies to peace,Profaners of this neighbour-stained steel,--Will they not hear? What, ho! you men, you beasts,That quench the fire of your pernicious rageWith purple fountains issuing from your veins,On pain of torture, from those bloody handsThrow your mistemper'd weapons to the ground,And hear the sentence of your moved prince.Three civil brawls, bred of an airy word,By thee, old Capulet, and Montague,Have thrice disturb'd the quiet of our streets,And made genomics's ancient citizensCast by their grave beseeming ornaments,To wield old partisans, in hands as old,Canker'd with peace, to part your canker'd hate:

Carole Goble

38

A tragedy?

As in Romeo and Juliette, the threats are political

and sociological

39

Creating ontologies has become a widespread cottage industry

• Professional Societies– MGED: Microarray Gene Expression Data Society– HUPO: Human Protein Organization

• Government– NCI Thesaurus– NIST: Process Specification Language

• Open Biological Ontologies– GO– Three dozen (and growing) other ontologies– Mostly in DAG-Edit, some in Protégé format

40

41

Government Continues to be a Major Driving Force

• Highly visible intramural initiatives to create public ontologies at many agencies, including NIST, NIH, VA, CDC

• Notable variation in these ontologies’– Scope

– Representational sophistication

– “Openness” of content

– Opportunities for peer review

42

NCI Enterprise Vocabulary Services

1997: R. Klausner, Director NCI, wanted a “science management system”

• Know about everything funded by NCI

• Goals and results – “bench to bedside”

- Thereby improve and speed translation of research

Approach:1. Create integrative terminology2. Evolve terminology scope from supporting grants

management to supporting science3. Build Web-accessible infrastructure – caCORE

43

44

More than 37,000 concepts are represented with extremely detailed granularity in many areas

45

Definitions may include considerable detail with respect to properties that establish relationships with other concepts

46

NCI Thesaurus is in Active Usenciterms.nci.nih.gov

ncicb.nci.nih.gov/core/EVS (more info)

Website: 1500-4000 page hits daily, 14K unique visitors (2004)

• API: NCICB & external applications

• Fulfills NCI and collaborators’ needs for controlled vocabulary

• Public domain, open content license

47

NCI Thesaurus Guidelines

• Develop content model (based on Ontylog

description logic from Apelon, Inc.)• Leverage existing sources as appropriate

– MeSH, VA NDF-RT, MedDRA …

• Develop unique content where needed– Cancer genes, gene products, cancer diagnoses, drugs,

chemotherapies, molecular abnormalities etc., and relationships among them

• Link to other standards using URLs where possible– OMIM, Swissprot, GO

48

:

ProductionRelease

ExternalTesting

NCI ThesaurusTest DTSServers

NCI ThesaurusEditing Environment

NCI ThesaurusWorkflow

Conflict Detectionand Resolution

Work ListGeneration

Classification

HxValidation

Hx

Baseline

Schema

Schema

Schema

Individual Editors’ TDE Workflow Client Editing Application DB Schema - Current NCI Baseline - Local History

Lead Editor TDE Work Manager Client Editing Application Conflict Detection/Resolution DB Schema - Master NCI Baseline - Master History

ChangeSet

WorkAssignment

CandidateRelease

Hx

NCI ThesaurusProduction

DTS Servers

Hx

Release

NCI uses an Elaborate Process for Editing and Maintenance

49

The NCI Thesaurus is not without its problems

• Upper level concepts are sometimes used inconsistently or not at all

• Textual definitions of concepts may not always reflect the meaning implied by the concepts’ position in the ontology

• Reliance on a proprietary knowledge-representation system – Prevents the ability to disseminate the ontology freely– Adds an unfortunate degree of uncertainty to the

semantics

50

Throughout this cottage industry

• Lots of ontology development, principally by content experts with little training in conceptual modeling

• Use of development tools and ontology-definition languages that may be– Extremely limited in their expressiveness– Useless for detecting potential errors and guiding

correction– Nonadherent to recognized standards– Proprietary and expensive

51

But the world is beginning to change!

• The Montagues do want to get the modeling right!

• The Capulets do want to see their work used by others!

• Useful, open tools and standards are now available that make it hard to justify closed, proprietary approaches

52

Some signs the world is changing …

• Developers of several overlapping and incompatible ontologies of anatomy suddenly are trying to understand why their models do not agree

• Philosopher Barry Smith suddenly is camping out at biomedical informatics meetings to get the attention of ontology developers

• NCI is piloting the use of OWL and Protégé to encode and manage the NCI thesaurus

• MGED and several other biomedical ontologies are being authored in OWL and Protégé from the beginning

• Downloads of the Protégé system continue to escalate

53

54

Total Protege RegistrationsThrough 10/13/04

0100020003000400050006000700080009000

10000110001200013000140001500016000170001800019000200002100022000

Jan '0

1

Apr

'01

Jul '

01

Oct

'01

Jan '0

2

Apr

'02

Jul '

02

Oct

'02

Jan '0

3

Apr

'03

Jul '

03

Oct

'03

Jan '0

4

Apr

'04

Jul '

04

Oct

'04

Month/Year

Regis

trati

ons

55

Protégé’s main features

• Simplified editing of ontologies and knowledge bases• Open-source distribution to encourage development by a

world-wide community of users• A plug-in architecture that enables developers to add new

features easily• Support for a wide range of representation formats

– CLIPS/COOL– XML Schema– UML– RDF– OWL

56

Protégé is ecumenical in its support for formal languages

• Open Knowledge Base Connectivity Protocol– CLIPS/COOL– UML– XML Schema– RDF and RDFS– Topic Maps

• Ontology Web Language (OWL)

57

Protégé remains successful because of its user community

• There are now 89 plug-ins available for use with Protégé• Collaboration with our users enables rapid debugging and

code fixes• Some development, such as the creation of extensions to

our basic OWL capabilities, has been a major collaborative experience

• Annual users groups meetings provide great opportunities for developers to share strategies, principles, and war stories

• Members of the international Protégé community are a huge support base for new users and for fledgling projects

58

The NCI Thesaurus

59

Bio-Pathway ontologies

60

Content Standard for Geospatial Metadata (Federal Geographic Data Committee)

61

Egyptian Crop Pests

62

Moving from cottage industry to the industrial age

• There must be widely available tools that are open-source, that are easy to use, and that adhere to knowledge representation standards: Protégé certainly is a candidate

• There must be a large user user community of developers who use the tools and who can provide feedback to one another and to the core team of tool builders

63

Moving from cottage industry to the industrial age II

• Government and professional societies must set expectations regarding the need for appropriate standards

• Government and professional societies must invest in educational programs to teach Montagues to identify with Capulets, and vice versa

• Demonstration projects must communicate to the potential developers of future ontologies the strengths and weaknesses of the guidelines, tools, and languages that facilitated the development work

64

A thousand flowers are blooming from every corner of the landscape

• Ontologies are being developed by interested groups from every sector of academia, industry, and government

• Many of these ontologies have been proven to be extraordinarily useful to wide communities

• Many of these same ontologies have been shown to be structurally flawed and of uncertain semantics

• We finally are at the stage where we have tools and representation languages that can lift us out of the grass roots to create durable and maintainable ontologies with rich semantic content

65

An infrastructure is now in place

• The need to build new ontologies in environmental health, phenotypic expression in model organisms, developmental biology, and many, many other domains is getting wide attention

• We finally have the tools and the languages to do things right

• Now all we need now is the will, the educational opportunities, and the community feedback to help developers at the grass roots to reemerge as philosophers and princes.

66

Let’s have a happy ending.